Journal of Intensive Care最新文献

{"title":"Early osmotherapy exposure and subsequent incident acute kidney injury in neurocritical care patients: a MIMIC-IV retrospective cohort study.","authors":"Shenshen Du, Shaojie Zhang, Weicheng Lai, Qimeng Wu, Shuang Cui, Shuqi Xu, Bo Hu","doi":"10.1186/s40560-026-00917-z","DOIUrl":"10.1186/s40560-026-00917-z","url":null,"abstract":"<p><strong>Background: </strong>Osmotherapy is frequently used in neurocritical care to manage cerebral edema and intracranial hypertension. However, its association with subsequent new-onset acute kidney injury (AKI), and whether early serum sodium or chloride burden materially attenuates this association, remain uncertain.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using MIMIC-IV version 3.1. Adult first-ICU neurocritical care patients were analyzed with a 48-h landmark design. The primary risk set included patients who were alive, remained in the ICU, and were AKI-free at 48 h after ICU admission. The primary exposure was any osmotherapy, defined as mannitol or hypertonic saline administered within the first 48 ICU hours, compared with no osmotherapy. The primary outcome was incident AKI after the 48-h landmark through ICU day 7 or ICU discharge. Multivariable regression was used as the main adjusted model; propensity-score weighting, overlap weighting, doubly robust models, and modified Poisson regression were used as complementary estimators. Sodium/chloride burden analyses were conducted in the lab-complete subset.</p><p><strong>Results: </strong>The final 48-h landmark cohort included 2,756 adult neurocritical care patients, of whom 624 (22.6%) developed incident AKI after the landmark. Any osmotherapy was administered to 365 patients (13.2%). In the doubly robust overlap-weighted logistic model, any osmotherapy was associated with subsequent incident AKI (OR, 1.48; 95% CI 1.12-1.96; P = 0.006). The corresponding doubly robust overlap-weighted modified Poisson estimate was RR 1.30 (95% CI 1.08-1.57; P = 0.006). Sodium/chloride burden analyses included 2,455 lab-complete patients. Early sodium burden (OR, 0.99; 95% CI 0.92-1.07; P = 0.792) and chloride burden (OR, 1.01; 95% CI 0.94-1.09; P = 0.743) did not materially attenuate the observed association in exploratory adjustment models. In exploratory clinical relevance analyses, patients with subsequent AKI had higher hospital mortality and lower creatinine-based renal recovery at ICU and hospital discharge. Dose-proxy and hypertonic saline concentration-specific analyses were exploratory because dose capture was incomplete and 23.4% hypertonic saline exposure was sparse.</p><p><strong>Conclusions: </strong>Among adult neurocritical care patients who were alive, remained in the ICU, and were AKI-free at the 48-h landmark, early osmotherapy exposure was associated with a higher risk of subsequent incident AKI. This association was not materially attenuated by early serum sodium or chloride burden in exploratory adjustment models. These findings support careful renal monitoring in patients receiving clinically indicated osmotherapy, while residual confounding by indication precludes causal interpretation.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Previous-day physical restraint duration as a bedside signal for following-day delirium: a retrospective patient-day analysis in a mixed ICU.","authors":"Aki Sasaki, Tomoki Kuribara, Takeshi Unoki, Junpei Haruna, Hiroomi Tatsumi","doi":"10.1186/s40560-026-00910-6","DOIUrl":"10.1186/s40560-026-00910-6","url":null,"abstract":"<p><strong>Background: </strong>Delirium is common in the intensive care unit and associated with adverse outcomes. However, bedside indicators that flag patients at high risk for delirium the following day are lacking. Although physical restraint has been linked to delirium, many prior studies relied on cross-sectional, same-day assessments that cannot exclude reverse causation. This study aimed to evaluate whether cumulative previous-day physical restraint duration was a bedside signal for following-day delirium.</p><p><strong>Methods: </strong>We conducted a single-center retrospective observational cohort study using patient-days (00:00-24:00 h) as the unit of analysis, with the exposure and covariates derived from more granular, time-stamped nursing records aggregated into calendar-day units. The exposure was cumulative physical restraint duration on the previous day, reported per 8-h increase. The outcome was incident delirium on the following day, defined as an Intensive Care Delirium Screening Checklist (ICDSC) score ≥ 4. The primary analysis was restricted to patient-days without previous-day delirium (ICDSC 0-3). We fitted a generalized linear mixed model with a random intercept for each patient. The restraint duration was modeled using a natural cubic spline (degrees of freedom = 3).</p><p><strong>Results: </strong>Of 1,482 patient-days from 281 patients, 263 patient-days were excluded due to coma. The primary analysis included 729 patient-days from 247 patients without previous-day delirium (115 incident delirium events, 15.8%). The association between restraint duration and following-day incident delirium was non-linear (likelihood ratio test, P < 0.001). Using no restraint as the reference, the odds ratios were 2.43 (95% confidence interval [CI], 1.64-3.61) at 8 h, 5.16 (95% CI 3.39-7.85) at 16 h, and 10.01 (95% CI 6.31-15.88) at 24 h. Sensitivity analyses using complete-case analysis, last observation carried forward, best-case/worst-case extreme scenarios, and adjustment for previous-day mental status yielded consistent results.</p><p><strong>Conclusions: </strong>In this single-center cohort, longer restraint duration on the previous day was associated with a higher risk of incident delirium the following day and may serve as a bedside-observable signal rather than evidence of a causal effect. Residual confounding may remain; prospective observational studies are needed to confirm this signal before its clinical utility is evaluated.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose esmolol attenuates sepsis-induced myocardial injury: association with improved autophagic homeostasis and PI3K/Akt signaling.","authors":"Xianfen Zhang, Qizhi Fu, Hengzhe Zhang, Haosen Song, Haobo Hao, Yingyang Li, Yun Sun","doi":"10.1186/s40560-026-00904-4","DOIUrl":"10.1186/s40560-026-00904-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis-induced myocardial injury (SIMI) contributes substantially to sepsis mortality. We investigated whether low-dose esmolol is associated with improved autophagy-related homeostasis and restored PI3K/Akt phosphorylation in SIMI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Human peripheral blood transcriptomic datasets (GSE28750, GSE232753, GSE134347, and GSE185263) and a rat septic myocardial dataset (GSE125042) were analyzed. Sprague-Dawley rats underwent cecal ligation and puncture (CLP) and received low-dose (5 mg·kg⁻1·h⁻1) or high-dose (15 mg·kg⁻1·h⁻1) esmolol infusion starting at 4h post-CLP. Autophagy was modulated with rapamycin, 3-methyladenine (3-MA), or chloroquine (CQ). Conscious hemodynamic monitoring, serial echocardiography, survival analysis, sepsis severity scoring, cardiac troponin I (cTnI) measurement, chamber-specific transmission electron microscopy, LC3/p62 co-localization, and TFEB subcellular localization were assessed. The unified endpoint was 18 h post-CLP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Bioinformatics analyses identified Akt1 and mTOR as hub genes and highlighted PI3K/Akt signaling as a candidate pathway associated with SIMI and esmolol response. Low AKT1 expression was associated with poorer survival in septic patients and showed moderate prognostic performance (AUC = 0.750). Rat myocardial transcriptomic data showed no transcriptional suppression of PI3K/mTOR components during sepsis. Sepsis suppressed PI3K/Akt phosphorylation, with p62 and LC3-II accumulation and TFEB cytoplasmic retention. Low-dose esmolol reduced tachycardia by 15-20% without hypotension, preserved left ventricular ejection fraction, lowered cTnI (1.36 to 0.14 ng/mL) and sepsis scores (18.50 to 8.50), and improved 144 h survival (P = 0.005). High-dose esmolol caused persistent hypotension and lacked survival benefit. Low-dose esmolol partially restored PI3K/Akt phosphorylation and enhanced TFEB nuclear translocation, reduced LC3/p62 co-localization, and ameliorated chamber-specific ultrastructural damage-mitochondrial swelling in the atrium and myofibrillar disarray in the ventricle-with findings suggestive of improved autophagosome-lysosome processing. CQ aggravated myocardial injury and autophagy-marker accumulation; low-dose esmolol partially attenuated CQ-induced deterioration. Direct quantitative measurement of autophagic flux and isoform-specific functional assays targeting PI3K were not conducted in the present study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Low-dose esmolol was associated with restored PI3K/Akt phosphorylation, enhanced TFEB nuclear translocation, and improved autophagy-related homeostasis in a rat SIMI model. We propose a working model in which low-dose esmolol may coordinate PI3K/Akt signaling and TFEB-mediated lysosomal adaptation to alleviate septic myocardial injury. The causal relationship cannot be definitively validated in the absence of direct flux monitoring, pathway-specific loss-of-function ex","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital development of new-onset frailty and discharge outcomes among patients with sepsis: a Korean multicenter registry study.","authors":"Eunjeong Choi, Kipoong Kim, Woo Hyun Cho, Jin Ho Jang, Ryoung-Eun Ko, Gee Young Suh, Chae Man Lim, Hye Ju Yeo","doi":"10.1186/s40560-026-00907-1","DOIUrl":"10.1186/s40560-026-00907-1","url":null,"abstract":"<p><strong>Background: </strong>Frailty is an important marker of vulnerability and poor outcomes in patients with sepsis. Although prior studies have primarily focused on pre-existing frailty or post-discharge outcomes, little is known about the in-hospital development of frailty among patients who are non-frail at baseline.</p><p><strong>Methods: </strong>We conducted a multicenter cohort study using the Korean Sepsis Alliance registry, a prospectively maintained database of adult patients with sepsis across 15 hospitals in South Korea. Analyses were restricted to patients without baseline frailty, defined as a premorbid Clinical Frailty Scale score < 5. The primary analysis categorized patients as remaining non-frail at discharge, having new-onset frailty at discharge, or dying during hospitalization. Multinomial logistic regression with prespecified covariates was used to evaluate clinical factors associated with these mutually exclusive outcomes, with in-hospital death treated as a competing outcome. Among hospital survivors, discharge destination was described according to discharge frailty status. In an exploratory analysis restricted to patients with new-onset frailty, we evaluated clinical factors associated with home discharge.</p><p><strong>Results: </strong>Among 6336 patients without baseline frailty, 1453 (22.9%) had new-onset frailty and 1527 (24.1%) died during hospitalization. Older age (per 1-SD increase, adjusted odds ratio [aOR], 1.38), higher Charlson Comorbidity Index (per 1-SD increase, aOR, 1.27), higher Sequential Organ Failure Assessment score (per 1-SD increase, aOR, 1.41), intensive care unit admission (aOR, 1.47), and pulmonary infection (aOR, 1.77) were associated after adjustment with new-onset frailty (all p < 0.001). Several of these factors were also associated with in-hospital death, with a larger adjusted estimate for SOFA score. Among hospital survivors with new-onset frailty, 42.8% were discharged home. In exploratory analyses restricted to patients with new-onset frailty, higher Sequential Organ Failure Assessment score, solid malignancy, and nursing home- or nursing hospital-acquired infection were associated with a lower likelihood of home discharge. In sensitivity analyses using inverse probability of censoring weighting, the overall pattern of associations for new-onset frailty remained generally consistent.</p><p><strong>Conclusions: </strong>New-onset frailty and in-hospital death were common among patients with sepsis who were non-frail at baseline. Assessment of frailty at admission and discharge may help characterize functional decline and inform discharge planning after sepsis.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mean arterial pressure-to-norepinephrine-equivalent dose ratio, rather than achieved mean arterial pressure alone, is associated with mortality in septic shock.","authors":"Xiaojun Zhao, Bo-Yang Wang, Shi-Tong Diao, Yangyanqiu Wang, Mao-Mao Cao, Yan Chen, Tian-Yuan Zhu, Rong Liufu, Shan Li, Chun-Yao Wang, Wen-Ying Han, Wei Jiang, Bin Du, Li Weng","doi":"10.1186/s40560-026-00912-4","DOIUrl":"10.1186/s40560-026-00912-4","url":null,"abstract":"<p><strong>Background: </strong>Higher mean arterial pressure (MAP) is commonly pursued in septic shock, yet randomized trials have failed to demonstrate a survival benefit-and patients achieving higher MAP often exhibit paradoxically greater mortality. We hypothesized this reflects impaired vascular responsiveness requiring greater vasopressor support, quantifiable by the MAP-to-norepinephrine-equivalent dose ratio (MAP/NEQ).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using two independent critical care databases (MIMIC‑IV and eICU). Adult patients with septic shock receiving vasopressors within 24 h of ICU admission were included. The primary exposure was the 24-h time-weighted average MAP (65-80 mmHg vs. ≥ 80 mmHg); the key secondary exposure was MAP/NEQ. The primary outcome was 28-day mortality. Cox regression, restricted cubic splines, and mediation analysis were performed.</p><p><strong>Results: </strong>A total of 7433 patients were included (MIMIC‑IV: n = 4944; eICU: n = 2489). Despite being younger with fewer comorbidities, patients with MAP ≥ 80 mmHg had higher 28-day mortality (MIMIC-IV: 19.5% vs. 12.6%; eICU: 20.5% vs. 11.0%; both P < 0.001). After adjustment for MAP/NEQ, the association between high MAP and mortality became non-significant, while MAP/NEQ remained independently and inversely associated with mortality in both cohorts (AUC 0.81 and 0.72). Mediation analyses revealed a suppression effect (- 33% and - 26%), indicating higher MAP coexisted with impaired vascular responsiveness. Subgroup and sensitivity analyses were consistent.</p><p><strong>Conclusions: </strong>Higher achieved MAP was not independently associated with 28-day mortality after accounting for vascular responsiveness. MAP/NEQ may serve as a clinically accessible tool for early risk stratification and identification of a vasoplegic phenotype in septic shock, though prospective validation is needed before clinical application.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical cardiac phenotype beyond ejection fraction: a missing dimension in prognostication of VA-ECMO outcomes in cardiogenic shock.","authors":"Sajid Kadir, Stephen Tran","doi":"10.1186/s40560-026-00897-0","DOIUrl":"10.1186/s40560-026-00897-0","url":null,"abstract":"","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":"14 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between the chronological phases of diffuse alveolar damage and clinical outcomes in acute respiratory distress syndrome.","authors":"Ko-Wei Chang, Chi-Hsien Huang, Shaw-Woei Leu, Tzu-Hsuan Chiu, Hsin-Yueh Fang, Huang-Pin Wu, Li-Pang Chuang, Wei-Hsun Chen, Chien-Hung Chiu, Ning-Hung Chen, Chung-Chi Huang, Han-Chung Hu","doi":"10.1186/s40560-026-00911-5","DOIUrl":"10.1186/s40560-026-00911-5","url":null,"abstract":"<p><strong>Background: </strong>Diffuse alveolar damage (DAD) represents the hallmark histopathological feature of acute respiratory distress syndrome (ARDS); however, its prognostic significance remains unclear. This study aimed to evaluate the associations between the chronological phases of histologically confirmed DAD and clinical outcomes in patients with ARDS.</p><p><strong>Methods: </strong>In this retrospective study, we included patients diagnosed with ARDS who underwent open lung biopsy between January 2002 and December 2025 or transbronchial lung cryobiopsy between January 2017 and December 2025. Rapid progression was defined as the presence of the proliferative phase within 7 days or the fibrotic phase within 21 days from ARDS diagnosis to lung biopsy.</p><p><strong>Results: </strong>A total of 90 patients were included in the analysis. No significant differences were observed in 28-day mortality (36.5% vs. 43.5%, p = 0.556) or 60-day mortality (63.5% vs. 69.9%, p = 0.601) between patients in the proliferative and fibrotic phases. In contrast, patients with rapid progression demonstrated significantly higher 28-day mortality (47.9% vs. 23.8%, p = 0.018) and 60-day mortality (72.9% vs. 50.0%, p = 0.025) than those without rapid progression. Multivariable analysis identified rapid progression as an independent predictor of 60-day mortality (hazard ratio, 2.274; p = 0.014). Furthermore, patients with rapid progression had significantly lower PaCO₂ levels prior to lung biopsy (43.4 ± 11.2 vs. 51.2 ± 21.1 mmHg, p = 0.013). Pneumothorax was the most common biopsy-related complication, occurring in 17.8% of patients.</p><p><strong>Conclusion: </strong>Rapid progression of DAD was associated with significantly poorer clinical outcomes, and patients with rapid progression had significantly lower PaCO₂ before lung biopsy. Larger controlled studies and additional physiological investigations are warranted to validate these findings.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From fluid responsiveness to fluid effectiveness: an endothelial perspective on fluid therapy in critical illness.","authors":"Hideshi Okada, Hiroyuki Tomita, Akio Suzuki, Toshiaki Iba","doi":"10.1186/s40560-026-00909-z","DOIUrl":"10.1186/s40560-026-00909-z","url":null,"abstract":"<p><p>Fluid responsiveness is the cornerstone of circulatory management in critical illness, offering a physiologically intuitive framework for guiding fluid therapy. Nonetheless, clinical experience and accumulating evidence suggest that an increase in cardiac output does not necessarily translate into improved microcirculatory perfusion, particularly during the advanced stages of critical illness. Such dissociation between macrocirculatory stabilization and persistent tissue-level hypoperfusion challenges conventional volume-centered resuscitation paradigms. This review revisits the concept of fluid responsiveness from a microcirculatory perspective and proposes endothelial integrity, rather than circulatory responsiveness alone, as an important determinant of the effectiveness of fluid therapy. By integrating classical physiology with contemporary insights into endothelial biology, this review highlights the endothelial glycocalyx as a functional interface that may influence intravascular fluid retention, vascular permeability, and hemodynamic coherence. Glycocalyx disruption, which is increasingly conceptualized as a component of \"endotheliopathy\" in critical illness, may be one mechanistic contributor to fluid unresponsiveness, progressive interstitial edema, and diminishing benefits of continued fluid loading. Additionally, this review discusses the implications of this framework for interpreting fluid trials, bedside assessment of tissue perfusion, and endothelial biomarker use to contextualize resuscitation strategies. Building on the established concepts of hemodynamic coherence and the revised Starling-glycocalyx model, this review introduces \"fluid effectiveness\" as a complementary framework alongside fluid responsiveness, providing a physiologically coherent approach to understanding when fluid therapy can translate into organ-level benefit and why this translation may fail as endothelial and glycocalyx injury progress.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of esketamine exposure with secondary sclerosing cholangitis in critically ill patients: a retrospective cohort analysis of 20,000 ICU cases.","authors":"Sebastian Zeiner, Julian Rettenbacher, Nikolaus Michael Nowak, Andreas Duma, Eva Schaden, Fabian Peter Hammerle, Daniel Laxar, Dieter Adelmann, Johannes Müller, Peter Wohlrab, Oliver Kimberger","doi":"10.1186/s40560-026-00906-2","DOIUrl":"10.1186/s40560-026-00906-2","url":null,"abstract":"<p><strong>Background: </strong>Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is a severe cholangiopathy with high mortality observed in ICU survivors. While prolonged mechanical ventilation and COVID-19-associated acute respiratory distress syndrome (ARDS) are established risk factors, the impact of ketamine, a commonly used sedative, remains controversial.</p><p><strong>Methods: </strong>This retrospective study included 20,973 ICU patients admitted between January 2014 and February 2022 at a tertiary university hospital. Patients with severe cholestasis were preselected (n = 532) and reviewed for SSC-CIP diagnosis or likelihood of SSC-CIP. Multivariate logistic regression was used to evaluate Esketamine exposure and dose dependency while controlling for other risk factors.</p><p><strong>Results: </strong>SSC-CIP was confirmed in 0.11% of patients; 0.20% had clinical profiles compatible with undiagnosed SSC-CIP. Among COVID-19 ICU patients, the incidence was 3.24%. Esketamine administration was significantly associated with SSC-CIP (70% of SSC cases vs. 7% controls). In a multivariate analysis, cumulative Esketamine dose (OR 1.021 per gram), ICU duration (OR 1.031/day), and COVID-19 status (OR 20.6) were independent predictors.</p><p><strong>Conclusion: </strong>Esketamine exposure was associated with SSC-CIP in a dose-dependent manner, highlighting the need for judicious sedative use in critically ill patients. Our cholestasis-first screening strategy also demonstrates a novel approach for detecting previously unrecognized SSC-CIP cases. Future prospective trials should evaluate the benefits of ketamine-free sedation strategies in high-risk populations.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Troponin T clearance via continuous renal replacement therapies in the ICU.","authors":"Sean Boyd, Sabina Mason, Sean Griffin, Britto Pereppadan, Stephen Moyles, Krishna Reddy, Colm Keane, Eoin Begley, Evelyn Deasy, Maria Donnelly, Julio Chevarria, Deirdre M D'Arcy, Yvelynne P Kelly","doi":"10.1186/s40560-026-00900-8","DOIUrl":"10.1186/s40560-026-00900-8","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to compare the removal of cardiac troponin T via continuous venovenous haemofiltration (CVVH), continuous venovenous haemodialysis (CVVHD) and continuous venovenous haemodiafiltration (CVVHDF) as a function of circulating blood troponin T levels in critically ill patients.</p><p><strong>Methods: </strong>This was a single-centre, prospective observational study conducted at Tallaght University Hospital (Dublin, Ireland). Adult patients admitted to ICU and commenced on continuous renal replacement therapy (CRRT) were included. All patients required a troponin T level > 50 ng/L. All patients were required to have commenced CRRT > 4 h prior to first sample. The aim was to take three serum samples per patient every 24 h, over a total of 72 h, with simultaneous sampling of the waste effluent for troponin T. Our primary outcome measure was estimated troponin T clearance according to CRRT modality.</p><p><strong>Results: </strong>We found no significant difference in estimated troponin T clearance according to CRRT modality (overall median troponin T clearance of 2.6 ml/kg/h). As a secondary outcome, it was noted that the percentage of troponin T clearance was statistically significantly higher for CVVH compared to CVVHD and CVVHDF (16% vs. 15% vs. 10%, respectively; p = 0.002).</p><p><strong>Conclusions: </strong>No significant difference in estimated troponin T clearance was found according to CRRT modality. Our results show that clearance of troponin T on CRRT is generally small across all modalities and that ongoing treatment with CRRT is unlikely to substantially impact interpretation and tracking of troponin T results in patients with concern for acute coronary syndrome.</p>","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}